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Date run 10/5/2020 10:41:44AI SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 10/5/2020 <br /> Record Selection Caere: Facility ID FA0026006 <br /> Make changeslcorrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION Number of facilities for this owner: 1 SSN/Fed Tax ID <br /> Owner ID OW0024659 New Owner ID <br /> Owner Name ZAMORATORRES, JORGE <br /> Owner DBA ELCENTENARIO <br /> OwnerAddress 2809 S MONROE ST <br /> STOCKTON, CA 95206 <br /> Work/Business Phone Not Specified <br /> Alternative Phone 925-785-9077 <br /> Mailing Address 2809 S MONROE ST <br /> STOCKTON, CA 95206 <br /> Care of ZAMORATORRES, JORGE <br /> FACILITY FILE INFORMATION APN 14723003 <br /> Facility lD/CERS ID FA0026006 <br /> Facility Name EL CENTENARIO#99054Z1 <br /> Location 730 S CALIFORNIA ST <br /> STOCKTON, CA 95206 <br /> Phone 209-464-9707 xCOMM <br /> Mailing Address 2809 S MONROE ST <br /> STOCKTON. CA 95206 <br /> Care of ZAMORATORRES, JORGE <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name ZAMORATORRES, JORGE <br /> Title <br /> Day Phone 209-464-9707 xCOMM <br /> Night Phone 925-785-9077 Cell <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0049264 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name ELCENTENARIO#99054Z1 (CirdeOne) <br /> Email invoice to(up to 2 entails) 1 ' I V/ <br /> Email permit to(up to 2 entails) L• I/I J/)J( n,17� I <br /> Account Balance as of 10/5/2020: $0.00 tt1dddyyyVV✓��� // ry <br /> ` V (Circe One) <br /> Transfer to AdivaJl rads. <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 1635-MOBILE FOOD PREPARATION UNIT(MFPU) PR0545996 EE0003361 -MARIBEL FLOHRSCHUTZ Active Y N A 6? D <br /> BILLING and COMPLIANCE ACKNOwtEDGEMENT. I,the undersigned owner,operatcror agent of same,acknowledge that all site,anclor project specific,PHS'EHD hourly charges associated with this facility <br /> or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinance Codes andior Standards and State andor <br /> Federal Laws. <br /> APPLICANT'S SIGNATURE: Date / / <br /> Program Records to be TRANSFERED: $25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date <br /> Payment Type Check Number Receive by . <br /> EHDStaff. - Date1�/�/ 01� Account out: Date_/ /-24)2,� <br /> COMMENTS: <br /> Invoice#: <br /> ro -ba �ine s S <br />